Group Activity: Heart and Neck

Assessment Workshop
Objective : To understand the anatomy and physiology of the
heart and neck, identify normal and abnormal heart sounds,
rhythms, and neck vessel conditions, develop proficiency in
assessment techniques for the cardiovascular and neck systems
and learn the clinical significance of assessment findings.
Group Set up : Divide participants into 7 groups, each
consisting of 8 members. Each group do a focused group
discussion focusing on specific aspects of heart and neck. Time:
15 minutes.
1. Importance of comprehensive cardiovascular and neck assessments in
nursing practice / Basic anatomy and physiology of the heart and neck
vessels.
2. Personal and family history of cardiovascular disease / Lifestyle factors,
medications, and relevant symptoms
3. Inspection, palpation and auscultation of the neck.
4. Inspection, palpation and auscultation of the heart.
5. Assessing for conditions like heart failure, valvular diseases, and
atherosclerosis / Correlating neck vessel findings with cardiac assessment.
6. Develop clinical reasoning and diagnostic examinations.
7. Patient privacy and confidentiality / Legal responsibilities in
cardiovascular assessment.
 Comprehensive
Assessment of the
Heart and Neck
 Health History
Personal and Family History: Document any history of cardiovascular
diseases, such as hypertension, coronary artery disease, myocardial
infarction, heart failure, and congenital heart defects.
Lifestyle Factors: Assess smoking habits, alcohol intake, diet, exercise
routines, and stress levels.
Medications: Review all medications, including prescription, over-the-
counter, and herbal supplements.
Symptoms: Inquire about chest pain, palpitations, dyspnea, orthopnea
(SOB when lying down), paroxysmal nocturnal dyspnea ( shortness of
breath that awakens the patient), fatigue, edema, and syncope (fainting).
 Inspection
Neck:
• Inspect for jugular venous distention (bulging of the major veins in
your neck), which can indicate right-sided heart failure.
• Observe for carotid pulsations.
Precordium (area of the chest overlying the heart):
• Look for visible pulsations, lifts, or heaves (Forceful).
• Assess skin color and condition.
 Palpation
Neck:
• Palpate the carotid arteries one at a time to assess the amplitude and contour of the
pulse.
• Feel for any thrills (vibrations indicating turbulent/random blood flow).
Precordium:
• Palpate the point of maximal impulse (PMI), typically located at the 5th intercostal
space, midclavicular line.
• Palpate for any heaves or lifts, which suggest hypertrophy or other abnormalities.
• Check for thrills, which can indicate murmurs (Unusual Sounds).
 Auscultation
Neck:
Use the bell of the stethoscope to listen for bruits in the carotid arteries, indicating
turbulent blood flow often due to atherosclerosis.
Heart:
Auscultation Sites:
Aortic area (2nd right intercostal space)
Pulmonic area (2nd left intercostal space)
Erb’s point (3rd left intercostal space)
Tricuspid area (4th left intercostal space)
Mitral area (5th left intercostal space, midclavicular line)
 Correlation with Physical
Findings
Pulse and Blood Pressure: Measure and correlate with
other findings. Check for orthostatic changes.
Peripheral Circulation: Assess for signs of poor perfusion,
such as cool extremities, delayed capillary refill, and
peripheral edema (Leg swelling).
 Peripheral Vascular System Assessment
Health History
Personal and Family History: Document any history of peripheral vascular diseases,
such as peripheral artery disease (the narrowing or blockage of the vessels that carry
blood from the heart to the legs), deep vein thrombosis (blood clot in a vein usually in the
legs), varicose veins (swollen, twisted vein), or any vascular surgeries.
Lifestyle Factors: Assess smoking habits, diet, exercise routines, and occupation, as
these can impact vascular health.
Medications: Review all medications, including anticoagulants (medicines that help
prevent blood clots), antiplatelets, and other cardiovascular drugs.
Symptoms: Inquire about leg pain or cramps, numbness, tingling/irritation, coldness,
color changes, swelling, ulcers, or slow-healing wounds.
 Inspection
Skin Color and Condition: Look for pallor, cyanosis, erythema, or
any other discoloration.
Hair Distribution: Note any changes in hair growth on the legs, as
poor circulation can lead to hair loss.
Edema: Observe for swelling, especially in the lower extremities.
Ulcers and Lesions: Inspect for any non-healing wounds or ulcers,
particularly around the ankles and feet.
Varicosities: Check for varicose veins.
 Palpation
• Temperature: Assess the temperature of the skin, comparing both sides to
detect any differences which might indicate compromised blood flow.
• Pulses: Palpate the peripheral pulses to assess their presence, amplitude, and
symmetry. Key pulses include:
• Radial, Brachial, Femoral, Popliteal, Posterior tibial and Dorsalis pedis.
• Capillary Refill: Assess capillary refill time by pressing on a nail bed until
it blanches and then releasing, noting the time it takes for color to return
(normal is less than 2 seconds).
• Edema: Grade pitting edema on a scale from 1+ (mild) to 4+ (severe).
Functional Assessment
• Evaluate the impact of cardiac symptoms on daily activities
and exercise tolerance.
• Assess for fatigue and its effects on quality of life.
•For Peripehral Vascular System:
• Evaluate the impact of peripheral vascular symptoms on
daily activities and mobility.
• Assess for intermittent leg pain or cramps and its effects on
walking and exercise tolerance.
 Diagnostic Tests
◦ Electrocardiogram (ECG): May be performed to assess electrical activity of the
heart.
◦ Echocardiogram: Used to visualize heart structure and function.
◦ Blood Tests: May include lipid profile, cardiac enzymes, and other relevant markers.
For Peripehral Vascular System:
◦ Ankle-Brachial Index (ABI): A simple, non-invasive test to compare the blood
pressure in the ankle with the blood pressure in the arm to check for PAD.
◦ Allen Test: Used to evaluate the adequacy of collateral circulation before arterial
blood sampling from the radial artery.
◦ Trendelenburg Test: Used to assess venous valve competence in patients with
varicose veins.
Patient Education and Counseling:
 Encourage open communication and regular follow-ups for ongoing
monitoring and support.
 Discuss the importance of medication adherence, diet, exercise, and
heart-healthy lifestyle choices.
For Peripehral Vascular System:
 Educate patients on risk factor modification (smoking cessation, diet,
exercise).
Discuss the importance of foot care, especially in patients with diabetes.
Teach patients about the signs and symptoms of DVT and PAD, and when
to seek medical attention.
 Documentation
• Document all findings comprehensively and
accurately.
• Use standardized terminology and follow
institutional protocols.
• Ensure clarity, accuracy, and confidentiality in
documentation practices.
 Ethical and Legal Considerations
• Maintain patient privacy and confidentiality.
• Obtain informed consent before conducting
any invasive procedures.
• Adhere to ethical standards, professional
boundaries, and legal regulations related to
patient care.
 “Hardships often prepare
people for an extraordinary
destiny.”

-C.S. Lewis-